Flashcards in Prolapse Deck (32)
definition of urinary incontinence?
involuntary loss of urine which can be demonstrated and is a social or hygienic problem
leakage of urine during raised intra abdominal pressure?
stress urinary incontinence
leakage associated with urgency, usually with detrusor activity?
what would detrusor hypotonia cause?
symptoms of urinary incontience?
precipitated by stress or urgency. Irritative symptoms:frequency, urgency, nocturne, dysuria
voiding difficulties: poor stream, incomplete emptying
most common form of incontinence?
stress incontinence (48 percent of women)
how would you investigate incontinence?
urinalysis, bladder chart, URODYNAMICS
useful investigation to differentiate between stress incontinence and urge?
urodynamics contains uroflowmetry and cystometry
what is flow rate?
measures peak flow, mean flow and voided volume
a method by which the pressure/volume relationship of the bladder is measured during filling, provocation and voiding
what would stress in look like on graph?
spikes of urine flow after cough or sneeze
involuntary detrusor contractions
bladder outlet obstruction?
high detrusor/bladder pressure. low flow arte/no flow rate
treatment of stress incontinence?
stress - dul
lifestyle - stop smoking, weight loss, avoid caffeine drinks etc. physio for pelvic floor retraining.
which drug (combined noradrenaline and serotonin repute inhibitor) increases intraurethra closure pressure?
surgical procedures for stress incontinence?
low tension vaginal tape, intraurethral injection, artificial sphincters, colposuspension
treatment of overactive bladder
OAB - oxy
avoid caffeinated drinks, bladder training. Oxybutanin (anti muscarinic drugs)
OAB - oxybutanin
surgical? (rarely used)
pelvic organ prolapse. classifications?
1st degree (in vagina)
2nd degree (at introits)
3rd degree (outside vagina)
procidentia - completely outside vagina
term for prolapse completely outside vagina?
types of pelvic organ prolapse?
urethrocele (urethra), cytocele (bladder), rectocele(rectum) enterocele (pouch of douglas containing small bowel) vaginal vault, uterus and cervix
symptoms of uterovaginal prolapse?
backache, ulceration of procidentia, coital difficulties, urinary retention, constipation,
management of prolapse?
rassure, avoid heavy lifting, lose weight, stop smoking, reduce constipation, vaginal oestrogen, only if symptomatic atrophic vaginitis, physiotherapy
women unfit for surgery or awaiting surgery?
when do you consider surgical management?
only after failed conservative management
sacrospinous ligament fixation - what is this?
securing vaginal vault to sacrospinous ligament using sutures
what group of people have problem with oxybutanin?
biggest problem with oxybutanin?
what type of drug is oxybutanin?
how long does oxybutanin take to start working?